There is little debate that health care in the United States is in need
of reform. But where should those improvements begin? With insurers?
Drug makers? The doctors themselves? In Big Med, David Dranove and
Lawton Robert Burns argue that we're overlooking the most ubiquitous
cause of our costly and underperforming system: megaproviders, the
expansive health care organizations that have become the face of
American medicine. Your local hospital is likely part of one. Your
doctors, too. And the megaproviders are bad news for your health and
your wallet.
Drawing on decades of combined expertise in health care consolidation,
Dranove and Burns trace Big Med's emergence in the 1990s, followed by
its swift rise amid false promises of scale economies and organizational
collaboration. In the decades since, megaproviders have gobbled up
market share and turned independent physicians into salaried employees
of big bureaucracies, while delivering on none of their early promises.
For patients this means higher costs and lesser care. Meanwhile,
physicians report increasingly low morale, making it all but impossible
for most systems to implement meaningful reforms.
In Big Med, Dranove and Burns combine their respective skills in
economics and management to provide a nuanced explanation of how the
provision of health care has been corrupted and submerged under
consolidation. They offer practical recommendations for improving
competition policies that would reform megaproviders to actually achieve
the efficiencies and quality improvements they have long promised.
This is an essential read for understanding the current state of the
health care system in America--and the steps urgently needed to create
an environment of better care for all of us.
